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Comparison of Pediatric Early Warning Score to Physician Opinion for Deteriorating Patients
J B Fenix1, Catherine W Gillespie2, Amanda Levin2
1Children's National Health System, Washington, District of Columbia; and jb.fenix@gmail.com.
Insights
The Pediatric Early Warning Score (PEWS) effectively identifies pediatric intensive care unit (PICU) patients at risk for deterioration, outperforming physician opinion. PEWS is a valuable tool for early detection of critical changes.
Area of Science:
- Pediatric critical care medicine
- Clinical risk assessment tools
- Patient deterioration prediction
Background:
- Identifying pediatric patients at risk of deterioration in the ICU is crucial for timely intervention.
- Physician judgment is a traditional method for assessing patient risk.
- The Pediatric Early Warning Score (PEWS) is a potential tool to aid in risk stratification.
Purpose of the Study:
- To compare the effectiveness of the Pediatric Early Warning Score (PEWS) against physician opinion in identifying patients at risk for deterioration.
- To evaluate the predictive value of PEWS and physician assessment for adverse events in the PICU.
Main Methods:
- Retrospective analysis of electronic medical records for 97 non-elective PICU transfers.
- Maximum PEWS and "senior sign-out" (SSO) list assignment were recorded.
- Deterioration events (intubation, high-flow nasal cannula, inotropes, etc.) within 12 hours of PICU transfer were identified.
- Multivariate regression analysis was used to assess associations with deterioration.
Main Results:
- Patients experiencing deterioration events had significantly higher maximum PEWS scores (3.9 vs 2.9, P = .01) compared to those without events.
- The association between PEWS and deterioration remained significant after multivariate adjustment.
- Physician opinion, indicated by SSO assignment, showed only a marginal association with deterioration risk.
Conclusions:
- The Pediatric Early Warning Score (PEWS) is a significant predictor of deterioration in PICU patients.
- Physician opinion alone was not strongly associated with subsequent deterioration.
- PEWS demonstrates value as a standalone or adjunctive tool for identifying vulnerable pediatric patients.
Background:
This study compares a Pediatric Early Warning Score (PEWS) to physician opinion in identifying patients at risk for deterioration.
Methods:
Maximum PEWS recorded during each admission was retrospectively ascertained from electronic medical record data. Physician opinion regarding risk of subsequent deterioration was determined by assignment to an institutional "senior sign-out" (SSO) list that highlights patients whom senior pediatric residents have identified as at risk. Deterioration events were defined as intubation, initiation of high flow nasal cannula, inotropes, noninvasive mechanical ventilation, or aggressive fluid resuscitation within 12 hours of transfer to the PICU. We assessed the relationships of sociodemographic variables, PEWS, and SSO assignment with subsequent deterioration events using multivariate regression analysis to control for a number of covariates.
Results:
There were 97 patients with nonelective transfers to the PICU who were eligible for placement on the SSO lists before transfer, 51 of whom experienced qualifying deterioration events. Maximum recorded PEWS was significantly higher for patients with a subsequent deterioration event during the first 12 hours after transfer, compared with those who were transferred but did not experience a deterioration event in the first 12 hours (mean [SD]: 3.9 [2.0] vs 2.9 [2.0]; P = .01). This association persisted even after multivariate adjustment. SSO assignment was only marginally associated with risk of deterioration among this patient population, with or without adjustment for covariates.
Conclusions:
The PEWS was significantly associated with ICU deterioration, whereas physician opinion was not. Used alone or in conjunction with physician assessment, PEWS is a valuable tool for identifying patients vulnerable to acute deterioration.
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